公益性医疗服务的有效供给

医疗服务公益性是我国卫生政策的核心价值取向,由于医疗服务供给与需要存在诸多特点和矛盾,公益性医疗服务供给还面临许多困难,需要一个制度体系来加以克服,以政府宏观控制与医院运行机制为核心内容的制度逻辑源于对医疗服务公益性内涵和问题实质的探讨。     

论医院医疗服务供给的效率与公平

效率和公平已成为各国健康服务保障改革中两个最基本的原则 ,也是政府干预医疗服务市场的二大主要目标。二者的确定方法与应用研究也成为全球性热点课题。医疗服务供给的经济学分析通常集中在“4Ｅ”指标 ,即效果 (Ｅｆｆｅｃｔｉｖｅｎｅｓｓ)、经济 (Ｅｃｏｎｏ ｍｙ)、效率 (Ｅｆｆｉｃｉｅｎｃｙ)与公平 (Ｅｑｕｉｔｙ) [1] 。国内开发医疗服务市场以来 ,医院医疗服务供给的主要成绩表现在效果与经济效益的提高 ,代价则是效率与公平的下降 ,“4Ｅ”形成了交叉走势。医院医疗服务供给效率包括技术效率 (Ｔｅｃｈｎｉ ｃａｌｅｆｆｉｃｉ…     

试述我国医疗服务的需求与供给

试述我国医疗服务的需求与供给张晓玉作者单位：１０００８８北京市，解放军第二六二医院改革开放以来，我国医疗卫生事业随着国家经济建设的发展取得了显著的成就。同时，我国医疗服务体制在实现适应市场经济体制变革的过程中也出现了新情况、新问题。当前，我国医疗服务...     

医院医疗服务供给的经济学实证研究概述

为探讨新时期我国医疗服务供给的经济规律与行为模式 ,以福利经济学与供给经济学为依据 ,以计量经济学模型为主要方法 ,通过对某市城乡全部县及县以上的 2 2所医院供给医疗服务的现况的调查分析 ,对供给的能力、技术效率、配置效率、配置公平性、技术效率与配置效率、公平与效率的相互作用进行系统的实证研究 ,从而为建立医疗服务供给经济学研究的基本方法 ,为适应医疗服务需求 ,提高医疗机构的可持续发展能力提供了理论依据     

医疗服务供给系统的组织设计

本文研究医疗服务系统的组织设计。医疗服务机构规模的扩张及多层级设计的趋势,需要将医疗人力资源整合到管理型保健组织中,同时,也要将以病人为中心的服务理念带进整个组织设计中。     

农村医疗服务供给模式应积极创新

十二五期间,农村医疗卫生服务将获得更多的投资,如何使有限的资金发挥积极效用。不仅取决于资金数量,也取决于资金使用的方式和方法。     

军人医疗服务需求与供给变化分析

近年来,由于受内外环境变化的影响,军人医疗服务需求与供给也随之发生一定程度的变化。本课题针对医疗机构和伤病员之间的供需情况进行了系统分析,目的旨在掌握军人医疗服务需求与供给的变化情况,发现存在的问题与发生问题的结点,以利于及时采取有效措施,保证军人医疗服务需求的合理供给。另外,也为决策部门提供科学的决策依据,有针对性地适时调整医疗政策,实现军队卫生资源优化配置、高效利用,最终达到军人医疗服务需求与供给持续平衡,军人医疗服务保障水平不断提高的目的。研究发现：师级规模医院医疗服务供需基本保持平衡,其供给水平能够满足保障对象基本医疗服务需求;军人医疗服务需求中过度医疗需求明显,造成医疗机构供给总量增加,负担加重;医疗服务的供需结构存在不合理现象,在费用需求和供给中,都显示药品费比例偏高;标准经费拨款水平偏低,尚不能满足医疗机构费用供给需要,有待进一步提高。     

区域内医院医疗服务供给系统效率研究

医疗服务系统效率 (Ｓｙｓｔｅｍｉｃｅｆｆｉｃｉｅｎｃｙ)分析是医疗服务供给的经济学分析的核心组成部分。以往系统效率分析通常采用单指标方法 ,测量以医院经营管理水平为主要内容的医疗服务技术效率。目前 ,学术界普遍认为系统供给效率是由医疗服务技术效率 (Ｔｅｃｈｎｉｃａｌｅｆｆｉｃｉｅｎｃｙ)与医疗资源配置效率(Ａｌｌｏｃａｔｅｅｆｆｉｃｉｅｎｃｙ)相互作用的结果。技术效率也称生产效率 (Ｐｒｏｄｕｃｔｉｖｅｅｆｆｉｃｉｅｎｃｙ) ,二者相辅相成 ,反映系统不同层次的投入产出效率 ,前者侧重于微观医院生产经营管理水平 …     

政府约束下的层化医疗服务供给探讨

本文在分析看病难、看病贵的主要矛盾后，提出了看病贵的主要矛盾是层化的医疗服务需求与非层化的医疗服务供给之间的矛盾。在此基础上提出了“政府约束下的层化医疗服务供给模式”，作为对解决群众看病难、看病贵的一种探索。     

Organizational Leadership For Building Effective Health Care Teams

The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.     

Challenges and Opportunities of Health Care Supply Chain Management in the United States

This article explores current supply chain management challenges and initiatives and identifies problems that affect supply chain management success in the U.S. health-care industry. In addition, it investigates the impact of health care supply chain management (SCM) initiatives on the overall organizational effectiveness. The attitudinal results, as well as the performance results presented in this study support the claim of health care proponents that the SCM allows organizations to reduce cost, improve quality, and reduce cycle time, and leads to high performance.     

居民就医选择与基层医疗机构的竞争性分析

目的探索影响城乡居民选择基层医疗机构就诊的影响因素,并为基层医疗机构发展提出建议。方法采用Logistic回归对中国健康与营养调查2009年截面数据进行分析。结果疾病严重程度、医疗保险状况、有无工作以及户籍是影响居民选择基层医疗机构就诊的关键因素。结论应当针对这些方面对目前政策做出调整以增强基层医疗机构竞争力。     

Managed Care Organizational Characteristics and Health Care Use among Children with Special Health Care Needs

Objective. To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children.
Data Sources. Telephone survey data from 2,223 parents of children with special health care needs, MCO-administrator interview data, and health care claims data.
Study Design. Cross-sectional survey data from families about the number of consequences of their children's conditions and from MCO administrators about their plans' organizational features were used. Indices reflecting the MCO characteristics were developed using data reduction techniques. Hierarchical models were developed to examine the relationship between child sociodemographic and health characteristics and the MCO indices labeled: Pediatrician Focused (PF) Index, Specialist Focused (SF) Index, and Fee-for-Service (FFS) Index, and outpatient use rates and charges, inpatient admissions, emergency room (ER) visits, and specialty consultations.
Data Collection/Extraction Methods. The telephone and MCO-administrator survey data were linked to the enrollment and claims files.
Principal Findings. The child's age, gender, and condition consequences were consistent predictor variables related to health care use and charges. The PF Index was associated with decreased outpatient use rates and charges and decreased inpatient admissions. The SF Index was associated with increased ER visits and decreased specialty consultations, while the FFS Index was associated with increased outpatient use rates and charges.
Conclusion. After controlling for sociodemographic and health characteristics, the PF, SF, and FFS indices were significantly associated with children's health care use patterns.     

Improvements in Health Status after Massachusetts Health Care Reform

Context

Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts relative to that in other New England states.

Methods

We used a quasi-experimental design with data from the Behavioral Risk Factor Surveillance System from 2001 to 2011 to compare trends associated with health reform in Massachusetts relative to that in other New England states. We compared self-reported health and the use of preventive services using multivariate logistic regression with difference-in-differences analysis to account for temporal trends. We estimated predicted probabilities and changes in these probabilities to gauge the differential effects between Massachusetts and other New England states. Finally, we conducted subgroup analysis to assess the differential changes by income and race/ethnicity.

Findings

The sample included 345,211 adults aged eighteen to sixty-four. In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%). Massachusetts residents also reported significant relative increases in rates of Pap screening (2.3%), colonoscopy (5.5%), and cholesterol testing (1.4%). Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.

Conclusions

Health care reform in Massachusetts was associated with improved health status and the greater use of some preventive services relative to those in other New England states, particularly among low-income households. These findings may stem from expanded insurance coverage as well as innovations in health care delivery that accelerated after health reform.     

老年居家卫生服务模型研究

目的：改善老年人的健康状况、提高其卫生服务可及性。方法：采用了专家研讨会和概念建模的方法。结果：老年卫生服务的目标是实现其健康老龄化和积极老龄化，途径是为他们提供连续的、全方位的、没有灰色带的、能够提高他们独立生活能力的综合性服务。老年居家卫生服务模型主要包括4个微观系统领域：自我管理支持、决策支持、递送系统设计和临床信息系统；服务内容包括初级卫生保健服务和社会服务两部分。结论：居家卫生服务对于提高老年人卫生服务可及性、提高其独立生活能力、改善其健康状况具有很强针对性。     

The Effects of Fraud on the Evaluation of Health Care

Studies on health care practices, financing, and organization increasingly rely on Medicare and other expanded data sets. These studies are of critical importance for public policy and for the development of strategies to contain escalating health care costs, but they often use data that have been corrupted by fraud and abuse. Mistaken conclusions, as to the effectiveness of policy and procedures, are likely being reached in studies that have used corrupted data. Researchers need to consider the suspect nature of results obtained from the corrupted data, and determine methods for making the data more valid.     

The Canadian Health Care System: An Analytical Perspective

The Canadian health care system is a publicly fundedsystem based on the philosophy that health is a right,not a commodity. The implementation of thisperspective is hampered by the fact that the CanadianConstitution makes health care a matter of provincialjurisdiction, while most taxing powers lie in thehands of the federal government. Further problemsarise because of Canada's geographic nature and a moveto regionalization of provincial health careadministration. The issue is compounded byrecent developments in reproductive technologies,aboriginal health, changes in consent law, etc.